Coping Mechanisms, Socioeconomic and Psychological Burden of Caregivers of Children with Bronchoasthma In Kakamega County General Hospital, Kenya

Abstract

Bronchoasthma is a heterogeneous chronic inflammatory non-communicable disease of lower respiratory airways characterized by spontaneous episodes. It is a life-course condition common among children, with variable intensities, frequencies and progression across population-groups. Worldwide, about 47.5 million children have bronchoasthma. In Kenya about 15.8%of children have bronchoasthma. Caregivers are integral to ensuring continuity of long-term care of these children for better health outcomes, yet little is known about their mental health experiences. Stable psycho-emotional health and coping among caregivers of these children is critical for improved home care context. Understanding coping, psychological and socioeconomic experiences of caregivers is desirable to enable development of mitigation strategies thus enhancing quality of home-care. The current study was conducted among caregivers of children with bronchoasthma attending Kakamega County Referral Hospital. It sought to determine: psychological burden among caregivers; Association between social-economic status and psychological burden, and; coping mechanisms adopted by caregivers; association between psychological burden and coping mechanisms, demographic and socioeconomic status. Using descriptive cross-sectional survey, data was collected through structured questionnaires from 408 parents and guardians of children with bronchoasthma in Kakamega County while Key Informant Interviews were conducted with 8 health workers. Data was analyzed descriptively. The mean age of caregivers was 33 years (Sd. 9.86). Majority (78.7%) were actual parents, of whom 73.5% were married. At least, 64% had primary-level education. Caregivers earning<10,000KES per month were 76%, majority of them being self-employed. Sleep disturbance on the night previous to the interview (0.001); caregivers’ concern about the child's asthma medication and side effects (p=0.001); feeling helpless (p=0.001) and; feeling frustrated or impatient (p=0.001) were statistically significant psychological concerns. Significant social and economic burdens included absenteeism from work (p=0.015), reduced total annual income (p=0.045); lost job (p=0.037); impaired daily activities (p= 0.001); discontinued child schooling (p= 0.011) and; delayed family investment/cut budgets (p= 0.015). Most of caregivers (73.5%; p=0.001) were using escape-avoidance coping mechanisms (not taking any constructive interventions) among whom 79.7% simply hoped for a full recovery of the child; 72.3% were involved in substance abuse (p= <0.001) while 68.6% downplayed the severity of symptoms because of myths and stigma. Young age (p= 0.002); being widowed (p= 0.040), and low level of education (p<0.001) were significantly associated with poor coping mechanisms. Conversely favorable psychological (p= 0.003) and social/economic status (p= 0.011) were positively associated with better coping. This study has demonstrated considerable psychological burden with adversarial coping particularly among economically disadvantaged caregivers. Targeted care including psychological and socio-structural support among this group is needful.